Provider Demographics
NPI:1821178708
Name:EVANS, SHERRI QUATTLEBAUM (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:QUATTLEBAUM
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:219 LAKE HILTON DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7524
Mailing Address - Country:US
Mailing Address - Phone:803-345-2636
Mailing Address - Fax:803-345-2636
Practice Address - Street 1:225 VISTA SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8119
Practice Address - Country:US
Practice Address - Phone:803-359-3195
Practice Address - Fax:803-359-3195
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist